<!--<?php
print <<<EOT
-->


<!--
EOT;
foreach ($LEFT_MENU_ARY as $k=>$v) { 
    if ($menu_id == $k) { 
print <<<EOT

					<tr>
                      <td><a href="{$v['url']}"><img src="./images/nav/{$v['pic']}-active.gif" alt="{$v['name']}" name="jf_nav_menu_$k" width="150" height="20" id="jf_nav_menu_$k" border="0"></a></td>
                    </tr>



EOT;
	} else {
print <<<EOT


					<tr>
                      <td><a href="{$v['url']}" onMouseOver="MM_swapImage('jf_nav_menu_$k','','./images/nav/{$v['pic']}-over.gif',1)" onMouseOut="MM_swapImgRestore()"><img src="./images/nav/{$v['pic']}.gif" alt="{$v['name']}" name="jf_nav_menu_$k" width="150" height="20" id="jf_nav_menu_$k" border="0"></a></td>
                    </tr>


EOT;
	}
} 
print <<<EOT
--> 

                
               
               	 <div class="main_R">    
               	   <div class="l-tb"> 
                <div class="tb-top-logo">
           <img src="css/images/about_jansen_furniture.jpg" alt="" />
            </div> 
             <div class="right-pad">       
             
                        <table width="415" border="0" cellspacing="0" cellpadding="0" class="registerform">
                          <tr>                          
                            <td   align="left" valign="top">

<!--
EOT;
if ($register_is_ok) {
print <<<EOT
--> 

                            <div>
                            Thank you for filling out the form.<br/>
                            We will contact you as soon as possible.
                            </div>

<!--
EOT;
} else {
print <<<EOT
--> 
                           
                            <form method="post" name="form1" action="register.php" onSubmit="return CheckDealerInquiryForm(this);">
		                    <table width="100%">
		                        <tr>
		                        <td height="20" colspan="3"></td>
		                        </tr>
		                        <tr>
		                            <td align="left" colspan="3">Complete the following in full if you are not currently registered with jans2en furniture.<br />
		                             We will contact you shortly. </td>
		                        </tr>
		                        <tr><td colspan="3"  height="10"></td>
		                        </tr>                        
		                        
		                        <tr>
		                            <td align="right" height="28">Company</td>
		                            <td width="5">:</td>
		                            <td align="left"><input type="text" name="dealerinquirycompany" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">First Name</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryfirstname" class="form" size="30"></td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">Last Name</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquirylastname" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">Business Type</td>
		                             <td>:</td>
		                            <td align="left">
		                            <select name="dealerinquirybusinesstype" class="form">
									  <option value="" selected>---Please Select---</option>
									  <option value="Importer">Importer</option>
									  <option value="Wholesaler">Wholesaler</option>
									  <option value="Retailer">Retailer</option>
									  <option value="Designer">Designer</option>
									  <option value="others">Others</option>
									</select>
		                            </td>
		                        </tr>
		                       <!-- <tr>
		                            <td align="right" height="28">Years In Business</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryyearsinbusiness" class="form" size="30"></td>
		                        </tr>-->
		                        <tr>
		                            <td align="right" height="28">Address</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryaddress" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <!--<tr>
		                            <td align="right" height="28">Address 2</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryaddress2" class="form" size="30"></td>
		                        </tr>-->
		                        <tr>
		                            <td align="right" height="28">City</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquirycity" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">State/Province</td>
		                             <td>:</td>
		                            <td align="left">
		                            <select name="stateid" class="form">
		                              <option value="" selected>---Please Select---</option>
		                              $state_select
		                            </select>
		                          </td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">Country</td>
		                             <td>:</td>
		                            <td align="left">
		                            <select name="countryid" class="form">
		                              <option value="" selected>---Please Select---</option>
		                              $country_select	
		                            </select> <span class="form_red">*</span>
		                            </td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">Zip/Postal Code</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquirypostal" class="form" size="30"></td>
		                        </tr>
		                        <tr>
		                            <td align="right" height="28">Phone</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryphone" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                       <!-- <tr>
		                            <td align="right" height="28">Fax</td>
		                             <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryfax" class="form" size="30"></td>
		                        </tr>-->
		                        <tr>
		                            <td align="right" height="28">Email</td>
		                            <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryemail" class="form" size="30"> <span class="form_red">*</span></td>
		                        </tr>
		                        <!--<tr>
		                            <td align="right" height="28">Company Registration Number</td>
		                            <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryregistrationnumber" class="form" size="30"></td>
		                        </tr>-->
		                        <tr>
		                            <td align="right" height="30">URL</td>
		                            <td>:</td>
		                            <td align="left"><input type="text" name="dealerinquiryurl" class="form" size="30"></td>
		                        </tr>
		                        <tr>
		                            <td align="right" valign="top" style="padding-top:3px">Where did you find us</td>
		                             <td valign="top" style="padding-top:3px">:</td>
		                            <td align="left" height="100"><textarea class="form area" name="find_us_content" cols="66" rows="4"></textarea></td>
		                        </tr>
		                       <!-- <tr>
		                            <td align="right" valign="top" style="padding-top:3px">Comments</td>
		                             <td valign="top" style="padding-top:3px">:</td>
		                            <td align="left" height="100"><textarea class="form area" name="comments" cols="66" rows="4"></textarea></td>
		                        </tr>-->
		                        <tr>
		                            <td align="right" valign="top" style="padding-top:3px">Info about your company</td>
		                            <td valign="top" style="padding-top:3px">:</td>
		                            <td align="left" height="100"><textarea class="form area" name="company_content" cols="66" rows="5"></textarea></td>
		                        </tr>
		                        <tr>
		                        
		                         <td></td>
		                         <td></td>
		                         <td height="28" >
		                                <input type="hidden" name="act" value="register">
		                                <input id="jf_button_send" type="image" src="css/images/jf_button_send.jpg"  onclick="form1.submit"   >&nbsp;
		                            </td>
		                        </tr>                        
		                    </table>
		                    </form>

<!--
EOT;
}
print <<<EOT
-->  
		                        
                            </td>
              
                           
                            
                          </tr>                         
                          
                        </table>
                        </div>
                        </div>
                         <div class="r-tb">
                        <div class="rightimgwrap"><img src="{$img}" alt="" name=""  class="picture"/></div>
                 
                     </div>
      <!-- right -->
          
   	</div>
	</div>
              </div>   
          
        
<!--
EOT;
?>-->